The federal auditor general is urging Veterans Affairs Canada to step up efforts to secure lower drug prices and look for ways to control spending on medical marijuana.

The auditor general’s latest report, tabled Tuesday in the House of Commons, found the department doesn’t have an adequate process in place for making evidence-based decisions related to its drug benefits list, nor does it have procedures in place to help ensure its formulary review committee systematically reviews evidence to support decisions about changes to the list.

The report set out four recommendations. The first is that the department explore ways to contain the costs of medical marijuana because Veterans Affairs’ expenditures have risen significantly since new regulations by Health Canada took effect in 2013.

Medical marijuana has become the highest-cost item paid for under the drug component of Veteran Affairs’ benefits program, according to the report, and the department expects expenditures could reach $25 million in the 2016-17 fiscal year — almost a third of the drug costs under the plan.

The department has been covering the costs of medical marijuana for the past seven years and advised the auditor general that it covered only the amount recommended by a physician or medical professional. More specifically, it has approved coverage for 10 grams per day, per veteran, which the auditor general says is double the amount identified as being appropriate in Veterans Affairs’ consultations with external health professionals, and three-times the amount Health Canada has reported as being commonly used by individuals for medical purposes.

The department has agreed to implementing a policy to contain the costs. In fact, Veterans Affairs Minister Kent Hehr said in a statement he requested a departmental review about six weeks ago to assess how the department provides marijuana for medical purposes as a benefit to veterans.

“We will use the results of the review, as well as information gathered from our consultations, to provide options which will ensure the ongoing health, safety and well-being of our veterans,” he added. “I look forward to providing an update on the review in the coming months.”

In relation to the auditor general’s findings on medical marijuana, Mike Blais, president and founder of Canadian Veterans Advocacy, calls the report “a generalized statement that affects doctor-client confidentiality. [It] doesn’t know why they are being prescribed or what they’re being prescribed.

“When we talk to cost, where was the government when [it] initiated this program, when it said it was OK for these growers to start production in Canada for medical marijuana? Every other pharmaceutical product that Canadians are provided have some form of regulatory control on it and a reference price.

“This is a viable, non-narcotic alternative that has worked very effectively on a scientific-test base, that is uncontaminated by politics and not contaminated by an illegal market. It’s disingenuous for us to be victims of this when the government should have been front and centre when [it] brought this in in 2008, defining what the cost would be.”

Another recommendation is that Veterans Affairs should periodically review whether strategies are leading to reduced costs for drugs and pharmacy services. The auditor general found that despite Veterans Affairs Canada’s entry into agreements with pharmacy associations in British Columbia and Saskatchewan, it continued to benefit from the agreed-upon reductions even through its deal with B.C. had expired in 2012.

In response, Veterans Affairs says it will bring in regular assessments and reviews of its formulary in addition to looking at strategies used by other drug plans. It also said it has begun working with other federal organizations and the pan-Canadian Pharmaceutical Alliance to explore opportunities.

The auditor general is also recommending that Veterans Affairs develop a well-defined approach to drug-use monitoring to help it manage its drug benefits program.

The report said the department had directed its provider, Medavie Blue Cross, to monitor claims data for high-risk use patterns for some drugs, such as narcotics and sedatives. However, the auditor general found the department hadn’t documented the direction it provided to Medavie. It also hadn’t directed Medavie Blue Cross to monitor and report regularly on trends in the drugs that veterans commonly use, such as antidepressants and non-steroidal anti-inflammatory drugs.

Veterans Affairs has agreed to enhancing its drug-use monitoring process. “Accordingly, the department intends to develop an efficient approach, governance structure and oversight to establish safeguards, monitor trends and determine potential risks that could affect the health and well-being of its veteran population,” according to the report.

The final recommendation from the auditor general is for Veterans Affairs Canada to implement a decision-making framework to decide which drugs to pay for and to what extent.

In response, Veterans Affairs has said it will implement the recommendations by May 2017. “We will act to implement each of these recommendations to make sure the health-care benefits program is efficient and effective for those using it,” said Hehr in a statement.

“We will also work to improve the delivery system in our department, across the government, and in partnership with the regulated health professionals who provide direct care to our veterans.”

Veterans Affairs Canada’s health-care benefits program provides drug benefits for eligible veterans, some of whom have complex health needs such as mental-health conditions, according to the report. In the 2014-15 fiscal year, the drug component of the benefits program covered drugs for roughly 51,000 veterans at a cost of $80 million.

The latest report from the federal auditor general urges Veterans Affairs to get a grip on its medical marijuana program for injured ex-soldiers, which is expected to cost taxpayers a startling $25 million this year.

Michael Ferguson says it’s just one of the programs where the federal government has critical data available to it that’s either not usable, not used or not acted upon at all.

The report tabled Tuesday in the House of Commons also looked at the dire condition of the army reserves, the federal government’s inability to detect and prevent refugee fraud, and the uncertain impact of the former Conservative government’s $400-million venture capital action plan.

But with medical marijuana for veterans, Ferguson paints a picture of program out of control.

He says the federal department long ago recognized the need to contain the prescribed pot program by imposing a limit on how much the government is willing to pay per gram, but usage levels and costs continue to climb.

Veterans Affairs has covered medical marijuana costs since 2008, but more vets have applied since the regulations were overhauled three years ago, sending the cost through the roof — Ferguson says it will soon account for almost one-third of all federal drug coverage for ex-soldiers.

“We found that before these new regulations were passed, department officials had identified that they would likely cause an increase in the number of veterans requesting marijuana for medical purposes, increasing the department’s expenditures,” said the audit.

Officials had documented that commercial suppliers were charging up to $14 per gram, almost triple the federal government’s estimate, it notes.

“Despite acknowledging this in advance, it did not establish a dollar limit for covering marijuana for medical purposes.”

n 2013-14, there were 112 veterans taking prescribed pot at a cost of $408,000, but by the end of December 2015 some 1,320 ex-soldiers were enrolled at a cost of $12.1 million. That adds up to an average of $9,600 per veteran.

The audit also found the department does not effectively monitor high-risk drug utilization among veterans, nor does it effectively manage its drug benefits list.

Veterans Affairs says it’s willing to pay for up to 10 grams of marijuana a day, per veteran — twice the threshold recommended by Health Canada. Ferguson questioned whether the department was doing the right thing and warned the policy could lead to some ex-soldiers getting hooked.

“According to an internal departmental briefing document, Health Canada indicated that more than five grams per day may increase risks with respect to the drug’s effect on the cardiovascular, pulmonary, and immune systems, and on psychomotor performance, and may increase the risk of drug dependence,” said the report.

“Despite the awareness of these potential risks, we found that the department had set the limit at 10 grams per day per veteran, and that in rare circumstances it could increase this limit after consulting with a veteran’s health care provider.”

The department agreed with the auditor’s concerns and said it had hired a pharmaceutical adviser to development guidelines in conjunction with other departments.

Canada's auditor general is warning of serious consequences from the way data is collected and used by the government, which he says is having a direct impact on the ability of the public service to serve and protect Canadians.

"One of the themes that ties a number of our audits together is that the data collected by many government organizations is either not usable, not used, or not acted upon," Auditor General Michael Ferguson said in his spring report tabled in the Commons today.

The audit highlights several gaps inside five government agencies, including the immigration, veterans affairs and defence departments.

The report also includes a special examination of two Crown Corporations, including Via Rail.

"I believe that government departments and organizations urgently need to turn their attention to this issue. They need to focus on collecting the right data to support their activities, on ensuring that data is well-managed and up-to-date, and on fully using this data not only to inform their core business, but also to support reporting and continuous improvement," Ferguson said in a written statement.

One of the five audits focused on how Veterans Affairs Canada is managing drug benefits for former servicemen and women, some of whom have complex health needs and suffer mental health conditions such as post-traumatic stress disorder (PTSD.) Approximately over one third of the program's recipients are over 80 years of age.

According to the auditor general, decisions about which drugs to cover were "poorly documented" and not always based on evidence.

For instance, in 2014, the department limited to 10 grams per day the amount of medical marijuana it would cover for eligible veterans — twice the amount shown to be safe — but the auditor general's office could not find any evidence to support this decision.

Other findings of the auditor general include:

Reserve soldiers are not fully prepared to deploy on missions due to the dwindling number of soldiers in the Canadian Army Reserve.While the selection processes for governor-in-council appointments such as chairpersons and full-time appointees were open and transparent, there was no documentation to support several part-time appointments.Receiving short-term approval of its funding and corporate plan, often late in the fiscal year, has made it difficult for Via Rail to carry out its operations in an effective manner.The spring report also focused on efforts by the department of immigration to detect and prevent citizenship fraud, which the auditor general found were inadequate.

According to the auditor general, a "weak" database system left immigration officers without up-to-date or even accurate information, limiting their efforts to combat citizenship fraud.

Question 2: Most providers of Cannabis handle the paperwork same as Pharmacies. They sent the paperwork to VA and fedex'ed my order. No payment required.I knew if I was turned down I would have to pay so I only ordered the "sample" variety to start.

Issue:Recent data gathered by Veterans Affairs Canada (VAC) demonstrates an increase in the costs related to the use of marijuana for medical purposes and the number of actual users. The number of Veterans reimbursed for marijuana for medical purposes has increased significantly over the past two years,from 112 Veterans in fiscal year 2013-2014 with associated expenditures of approximately $409,000, to 1,320 Veterans between April 1, 2015 and December 31, 2015, with associated expenditures of approximately $12.1 million.This data was recently released in response to a media request.It is anticipated this could generate questions to front-line staff.

Questions

1. How long has VAC been paying for marijuana for medical purposes for Veterans?2. I want VAC to pay for my marijuana, what do I need to do?3. Does Veterans Affairs Canada have a limit on how much is reimbursed for marijuana for medical purposes?4. I have been approved for VAC support for marijuana for medical purposes but for only 10 grams per day although my physician or health care practitioner authorized 15 grams per day. Will VAC reimburse me for the remaining 5 grams?5. Health Canada now allows Canadians to access cannabis oil, dried leaves and buds in addition to dried marijuana.Is VAC expanding their coverage to include payment of cannabis oil, dried leaves and buds?6. Does Veterans Affairs Canada reimburse travel costs incurred to obtain the services of a physician or health care practitioner who will authorize access to marijuana for medical purposes? My local physician or health care practitioner will not prescribe marijuana for me so I have to travel.

Q1 How long has VAC been paying for marijuana for medical purposes for Veterans?

AI. VAC made the decision to reimburse one individual for marijuana for medical purposes on compassionate grounds in 2007. Since 2008,VAC has been covering the cost of marijuana for medical purposes for Veterans who obtain the product in accordance with Health Canada's access regulations.

- Your name and client ID number (K number);- A copy of the completed medical document required under Health Canada's Marihuana for Medical Purposes Regulations (MMPR); and- a copy of your completed and confirmed registration with a licensed producer.

Q3. Does Veterans Affairs Canada have a limit on how much is reimbursed for marijuana for medical purposes?

A3. VAC may reimburse up to 10 grams per day of dried cannabis as authorized by your physician or health care practitioner.

Q4. I have been approved for VAC support for marijuana for medical purposes but for only 10 grams per day although my physician or health care practitioner authorized 15 grams per day. Will VAC reimburse me for the remaining 5 grams?

A4. VAC may initially reimburse up to 10 grams per day of dried cannabis as authorized by your physician or health care practitioner. A request in excess of 10 grams per day is reviewed by VAC's Director General of Health Professionals prior to a decision for reimbursement.

Q5. Health Canada now allows Canadians to access cannabis oil, dried leaves and buds in addition to dried marijuana. Is VAC expanding their coverage to include payment of cannabis oil,dried leaves and buds?

A5. At this time,VAC reimburses Veterans for dried cannabis only. Expanding coverage would only be considered when expert opinion and scientific evidence confirm the efficacy and safety of marijuana as a treatment benefit.

Q6. Does Veterans Affairs Canada reimburse travel costs incurred to obtain the services of a physician or health care practitioner who will authorize access to marijuana for medical purposes? My local physician or health care practitioner will not prescribe marijuana for me so I have to travel.

A6. Since many physicians and health care practitioners in Canada are permitted to authorize access to marijuana for medical purposes,VAC would not normally cover travel expenses to obtain authorization to access marijuana from a physician or health care practitioner outside of the Veteran's community.

All decisions are made on a case-by-case basis,so please include all relevant evidence with your claim or appeal.

I was unaware of the 10g for VA. The max limit as stated on the medical form when I got my card was 5g per day. Legally you can have a maximum of a month's supply (30 x your daily amount) or a maximum of 150g in your possession. http://www.hc-sc.gc.ca/dhp-mps/marihuana/info/faq-eng.php

I make tinctures which take up to 2 months to make. The pills are good for 3 months so I make them in batches. Heck, if I get caught with all this on hand I could be charged for being over the limit. I am not allowed to smoke or vape because of asthma induced by medications.

Last edited by Dove96 on Sun 01 May 2016, 10:04; edited 4 times in total (Reason for editing : Clarifying possession amounts)

Rex it makes me wonder how much big pharma has their fingers in this issue? And maybe the government?

Let's face it JT wants to legalize it and had the speech at the UN last week. Big pharma is losing their minds because they are nowhere near the ground floor. Former Heinz ketchup tomatoe growers have started growing marijuana.

I agree. Politicians and bureaucrats say that they support the use of medical marijuana, but yet allow old biases to taint their actions towards those who sell it, or use it. Just look at what is happening in BC with all those dispensaries. Forcing them to close because they are too close to schools or other restrictions. Yet since it is for medical use, they should not have any restrictions that are not imposed upon traditional pharmacies, that stock far more potent and dangerous controlled substances. Or the RCMP officer who was fired for smoking it, while in uniform, in spite of their own regulations that allow it, as long as it's prescribed. And now VAC, allowing for the use of it, but only with heavy restrictions.

It really doesn't matter what the difference in policy is. There is a vast difference between someone who is still wearing the uniform, and those who are too broken to wear it. The day that the military decided that we were no longer fit to be members, they lost all rights to tell me what I, and my fellow disabled veterans, are allowed to do. It's just that simple.

Veterans Affairs and Canadian military differ over the use of prescription pot

As the federal government tries to come up with a pot policy for military veterans, one medical marijuana user has some advice: don't limit how much prescription pot a veteran can eat, smoke or drink.

"I think there should be no cap and that every case should be judged on individual merit and that the doctor's prescription is paramount," said Mike Blais, president and founder of Canadian Veterans Advocacy.

Veterans Affairs currently covers the cost of up to 10 grams of medical marijuana per day for veterans. But in March, Veterans Affairs Minister Kent Hehr said he was "shocked" to find his department lacked an "informed policy" on the use of prescription marijuana, even as number of claims for medical marijuana by veterans grew more than tenfold over the last two years.

After hearing about the rise, Hehr asked for what he called an "internal review" of the policy. Officials have already spoken with doctors and will also consult medical marijuana providers and "beneficiaries," including Blais.

Blais applauds the government for consulting on the issue and said he's happy with the way things are proceeding. Still, he insists the question of quantity should be resolved between veterans and their doctors.

"I think it's grotesquely unfair for some bureaucrat in Prince Edward Island going through a cost analyst and checking over the money score and saying 'Oh geez, we're spending too much money here. We've got to cut them off.'

"No, no, no. These are real people. These people have gone to their doctors, their psychiatrists, their pain specialists, whoever has written out that prescription."

The minister's office said consultation is ongoing.

"Regarding veterans' concerns about access, that is why we are including them in the conversation, so that we can get the fullest picture possible of how any policy we develop will impact veterans," said Sarah McMaster, spokeswoman for Hehr.

Back in March, Hehr said he hoped the review would take a couple of months. His office didn't offer an updated timeline but said the conversations "will not result in an immediate report but will inform how the government moves forward on this file."

'Significant policy divergence'

Veterans Affairs has another issue to consider too: the Canadian Forces takes a very different stand on medical marijuana.

In a 2014 email obtained by CBC News under access to information laws, H.C. MacKay, who was then the deputy surgeon general of the Canadian Forces, wrote, "With respect to marijuana use for medical purposes, we have identified what appears to be a very significant policy divergence between VAC [Veterans Affairs Canada] and CAF [Canadian Armed Forces]."

MacKay wrote that while Veterans Affairs is funding the use of medical marijuana, the military's health service does not recognize it for medical use. Mackay, now a brigadier-general, noted "this may well capture media attention" and has the potential to confuse patients.

Asked about the current policy, a spokesperson for the Canadian Forces said there is no official directive on medical marijuana yet, but one is in the process of being approved.

Regarding the specific question of using medical marijuana to treat post-traumatic stress disorder, the Canadian Forces said there is not enough evidence to authorize its use and that, in fact, some evidence suggests it could be harmful.

While both Veterans Affairs and the Canadian Forces work on their medical marijuana policies, the federal government has announced it will introduce legislation to legalize and regulate the sale of recreational pot in the spring of 2017.